Written By: Mary Brintnall-Peterson, Ph.D., MBP Consulting, LLC, Professor Emeritus, University of Wisconsin – Extension
Several years ago, I was part of a team that conducted focus groups with military family caregivers to hear first-hand what they were experiencing and what types of educational programs they thought would be helpful to them. Our first hurdle was getting caregivers to participate in the focus groups because individuals didn’t identify themselves as caregivers. They didn’t realize they became a caregiver when notified of their loved one’s injury or long-term medical condition. Their life changed at that moment! In fact, it is often a professional who they interacted with, while providing care to their service member, that uses the term caregiver when talking with them. Over time they began to accept that they are indeed, a caregiver! By accepting that they are a caregiver, they take on a new identity.
The caregiver identity comes with expectations, rules, and is sometimes in conflict with their identity as a spouse, parent, sibling, etc. As you work with caregivers explore how they feel about their new caregiver identity which forces them to become an advocate, nurse, and protector while still being a spouse, partner, friend, or parent. Sometimes being a caregiver comes in conflict with their husband, parent, or sibling identity and causes stress. They find themselves asking, “Do I act as the caregiver or do I act as a spouse or partner in this situation?”
As professionals, we can help these new military caregivers understand the conflict they are feeling when their identities are in conflict with each other. An example of this conflict is a parent bathing their son who has a prosthesis. As a parent and caregiver, the individual understands the need for bathing and why it’s important to have someone help but don’t understand the emotions that surface when they do the task. As a parent the individual is thinking, “I shouldn’t be bathing my adult son” but as a caregiver the individual is thinking “he can’t do it by himself and I’m the caregiver.” The conflict between parent and caregiver identities make the individual feel uncomfortable.
One strategy to help the military caregiver understand the conflicting feelings or emotions is to have them jot down what they feel when it’s time to help bath their service member. When they put on their caregiver hat are the emotions different or the same when they have their parent hat on? Then talk about the emotions and where did they come from? Past experiences? Unwritten rules that a parent doesn’t bathe an adult child? Expectations that adult children take care of themselves? Thoughts about what a parent should or shouldn’t do with their adult children? Family values, culture, etc.? What’s important is to have the caregiver identify their feelings when needing to do a task they feel uncomfortable with and to explore what is causing them to be uncomfortable.
Another strategy is to have the caregiver list the tasks they did before they became a caregiver and comparing it to what they do now. Doing this provides a visual of exactly what they are doing and validates why they are so tired and overwhelmed. Next look at the list and discuss possible responsibilities or tasks they really don’t like or feel uncomfortable doing. When working with caregivers I’ve found the tasks they feel most uncomfortable doing are the ones that create stress. These are not things like caring for a wound or monitoring medications, they are usually something that has an emotional response. Focus on those tasks and try to determine why they are uncomfortable doing those particular tasks. Often you will find it relates back to their identity—its’ not comfortable for a daughter to do personal care for her father, for a wife to be making major decisions on her own, or for a friend to take over finances.
Each of these examples “break” a rule of the individual’s identity. In many families a daughter doesn’t see their father naked, thus when personal care is required they are uncomfortable doing the task. Friends typically don’t know about each other’s finances thus when they are required to assume the finances it “breaks” a rule. A couple typically makes major decisions together and when forced to do it alone the spouse feels uncomfortable. These simplistic examples attempt to illustrate how the task creates an emotional response. Understanding that the emotional response goes against a rule (often they don’t know they have the rule) that has guided their life. Their rules come from being in a family, experiences they have had, the communities they are a part of such as a religious group, the military, and even their heritage or culture.
Rules & Identity
Rules and identity go hand in hand and are complex and unique to each individual. They create emotional responses when caregivers assume a task or responsibility that goes against their rules. Helping caregivers understand that there are rules which they live by and when these rules are challenged they experience an emotional response. So, the goal is to “teach” caregivers to ask themselves why is what I’m doing making me emotional? What rule am I challenging and where did it come from? The reality is this process takes time and doesn’t have to be done while they are doing the task but can be explored at a later time. Help them focus on the items that create the most emotional stress and think about how that task can become less emotional for them. Some ways could include having someone else do the task, exploring the rule and determining if the rule is one you want to keep or not, change, throw out or modifying the task and/or rule so it doesn’t create stress. To learn more about the caregiver identity theory enroll in the free one-hour online course, Caregiver Identity Discrepancy and Implications for Practice.
Montgomery, R.J. V. & Kosloski. K. (2009). Caregiving as a Process of Changing Identity: Implications for Caregiver Support. Generations, 33, 47-52.
Montgomery, R. J. V. & Kwak. J. (2008). Tailored Caregiver Assessment and Referral (TCARE) process: An evidence-based model for effectively supporting caregivers. American Journal of Nursing, 108. 54-57.
Savundranayagam, M.Y., & Montgomery, R.J.V. (2010). Impact of role discrepancies on caregiver burden among spouses. Research on Aging, 32, 175-199.